Publications

Early 2023

Optical coherence tomography angiography (OCTA) is a non-invasive imaging technique that provides significant information about retinal and choroidal vasculature to diagnose and treat these conditions.

The purpose of this manuscript is to describe the fundamental principles of OCTA imaging, how OCTA images are interpreted, and how OCTA is used in the diagnosis and management of macular diseases.

Both novices and experienced clinicians will find the Atlas an invaluable reference because it is organized by disease categories and includes high-quality OCTA images and corresponding illustrations. This Atlas provides an exclusive perspective and insight into macular diseases and OCTA imaging, written by a leading expert.

This Atlas is an essential resource for ophthalmologists, optometrists, and researchers interested in macular diseases. In this course, you will learn more about OCTA imaging and deepen your understanding of it.

Clear and detailed vision depends on the macula, which is located in the center of the retina. Macular diseases, such as age-related macular degeneration, diabetic retinopathy, and retinal vein occlusion, are leading causes of vision loss worldwide. Optical coherence tomography angiography (OCTA) is a non-invasive imaging technique that provides significant information about retinal and choroidal vasculature to diagnose and treat these conditions.

Ophthalmologists, optometrists, and researchers in macular diseases will benefit from the Atlas of Optical Coherence Tomography Angiography for Approaching Macular Diseases. The purpose of this manuscript is to describe the fundamental principles of OCTA imaging, how OCTA images are interpreted, and how OCTA is used in the diagnosis and management of macular diseases.

Both novices and experienced clinicians will find the Atlas an invaluable reference because it is organized by disease categories and includes high-quality OCTA images and corresponding illustrations. This Atlas provides an exclusive perspective and insight into macular diseases and OCTA imaging, written by a leading expert.

Atlas of Optical Coherence Tomography Angiography for approaching macular diseases: A Guide to OCTa in Macular Disorders: Marashi MD, Ameen: 9798391667629: Amazon.com: Books

By Ameen Marashi (early 2023)


New technologies and research are being developed all the time in the field of retina care. Our patient's health depends on staying up-to-date with the latest guidelines and best practices.

With this concise and practical resource, clinicians can use the Clinical Retina Pocket Guidelines to make informed decisions about the diagnosis and treatment of retinal conditions. Evidence-based recommendations, algorithms, and quick-reference tables are conveniently organized for easy access in this pocket-sized guide.

The goal of this guide is to provide retina specialists, ophthalmologists, optometrists, and other healthcare professionals with valuable resources. We aim to provide the most relevant and use]ful information to enhance patient outcomes, so we encourage feedback and suggestions for improvement.

4&text=Ameen+Marashi+MDhttps://www.amazon.com/Clinical-Retina-Pocket-Guidelines-pocket/dp/B0BXZS6WX5/ref=sr_1_4?qid=1678802316&refinements=p_27%3AAmeen+Marashi+MD&s=books&sr=1-4&text=Ameen+Marashi+MD 

An atlas of fundus fluorescein angiography (FFA) images shows the various stages of an eye examination using FFA. FFA is a diagnostic imaging technique used to evaluate blood flow in the retina and choroid of the eye through the use of diagnostic imaging. It involves injecting fluorescein dye into a vein in the arm of a patient. As the dye circulates through the blood vessels in the eye, a series of photographs are taken to capture its movement through the blood vessels.

This atlas is designed to assist ophthalmologists, optometrists, and other eye care professionals in understanding and interpreting the results of the FFA procedure. It contains a wide range of images that show a range of normal and abnormal blood flow patterns, such as leaks, blockages, and abnormal growth of blood vessels. In addition, it has a variety of normal and abnormal blood circulation patterns. Various eye conditions may also be described and accompanied by annotations within the atlas in order to assist practitioners in identifying and diagnosing these conditions.

This atlas provides an invaluable resource for anyone involved in the diagnosis and treatment of retinal and choroidal disorders, providing a visual reference for the interpretation of FFA results and guiding their clinical decision-making process.

https://www.amazon.com/Fluorescein-Angiography-approaching-macular-diseases/dp/B0BW2G5M4J/ref=sr_1_2?crid=1E2ML11LQYZQP&keywords=Ameen+Marashi&qid=1678463869&sprefix=ameen+marashi%2Caps%2C257&sr=8-2

Atlas of structural Enface OCT for approaching macular diseases: The lost art (Atlas of OCT for approaching macular diseases)

By Ameen Marashi, MD (Late 2020)

Retinal diseases are one of the leading causes of visual impairment and are presented in our daily clinical practice. Optical coherence tomography (OCT) is an essential ancillary test when approaching and managing patients with macular disease. Optical coherence tomography (OCT) is a non-invasive method to evaluate macular pathologies. OCT offers C-scans (frontal scans) called Enface by possessing a 3D cube and slice it into each retinal layer.This atlas will help ophthalmologists know essential things to expect when approaching patients with macular diseases using structural Enface OCT. The atlas discusses main pathological findings, including anatomical changes post-treatment.We are living in the era of advanced multi-modal retinal imaging, including structural Enface OCT, which aids not only in confirming and archiving macular diseases.Structural Enface OCT will reveal subtle pathological changes in clinical examination, post-treatment plans, and the ability to assess treatment efficacy when following up patients with macular disease. The advancement of social media made telemedicine accessible to all colleagues worldwide to share experience remotely; hence structural Enface OCT contributed to easy sharing of clinical cases aiding in accurately approaching macular diseases. This atlas contains more than 185 images covering normal structural Enface OCT scan findings and artifacts, vitreomacular interface abnormalities, macular hole, retinal vascular diseases, choroidal vasculopathy, etc. Bruch's membrane diseases, hereditary diseases cystoid macular and choroidal rupture. This atlas helps ophthalmologists interpret structural Enface OCT easily to approach and follow up patients with macular diseases efficiently.Please forgive me if there are any spelling, grammar, or syntax mistakes as English is not my native language, and there are other copies of this manuscript in Arabic.For further assistance and information please contact me ameenmarashi@hotmail.com

Available at 

https://www.amazon.com/structural-Enface-approaching-macular-diseases/dp/B092ZX6M8Q/ref=sr_1_2?crid=683NTEZW9Y6K&keywords=%22Ameen+Marashi%22&qid=1639812327&s=digital-text&sprefix=ameen+marashi+%2Cdigital-text%2C214&sr=1-2-catcorr

 ‫أطلس التصوير المقطعي البصري لمقاربة أمراض اللطخة: تبسيط قراءة التصوير المقطعي البصري Atlas of OCT for approaching macular diseases (Arabic Edition) Kindle Edition

By Ameen Marashi, MD (Late 2020)

يعتبر التصوير المقطعي البصري OCT أحد أهم الاستقصاءات غير الغازية المساعدة في تقييم اللطخة. والذي بات مهماً في الممارسة السريرية اليومية لتشخيص ومقاربة وعلاج أمراض اللطخة.

يوفر التصوير المقطعي البصري إمكانية تقييم فعالية العلاج ومتابعة التغيرات المرضية في اللطخة عند المرضى كما يقدم مؤشرات إنذارية

قد تتنبئ بإنذار الرؤية.


يحتوي الأطلس على 230 صورة تغطي الموجودات الطبيعية في اللطخة والتغيرات لأشيع أمراض اللطخة كشذوذات السطح الزجاجي اللطخي وثقب اللطخة والأمراض الوعائية الشبكية واعتلالات المشيمية وأمراض غشاء بروك والأمراض الوراثية ووذمة اللطخة الكيسية ورضوض القسم الخلفي من العين.

يساعد الأطلس أطباء العيون في قراءة مقاطع التصوير المقطعي البصري بسهولة لمقاربة ومتابعة المرضى بفعالية.

عند قراءة الكتاب يفضل بوضعية العامودية(اللوحية)

Available at 

https://www.amazon.com/gp/product/B094B41SBC?ref_=dbs_mng_crcw_0&storeType=ebooks

Atlas of optical coherence tomography for approaching macular diseases

By Ameen Marashi, MD (Late 2020)

Optical coherence tomography (OCT) is one of the most critical imaging technique that offers non-invasive in vivo macular tissue evaluation, which becomes essential in day to day retinal practice when approaching and managing patients with macular diseases.

OCT offers the ability to assess treatment efficacy and follow up macular changes in patients with macular diseases and reveal biomarkers that may help predict visual prognosis.

This atlas contains more than 230 OCT images covering normal OCT scan findings, and types of OCT scans, and pathological findings along with the most common macular diseases such as vitreomacular interface abnormalities, macular hole, retinal vascular diseases, Bruch's membrane choroidal vasculopathy, hereditary diseases cystoid macular and posterior segment trauma.

This atlas help ophthalmologists interpret OCT easily to approach and follow up patients with macular diseases efficiently.

Acknowledgments:

I would give special thanks to Barbara Parolini for editing the vitreomacular interface and macular hole chapter with me.

I would love to thank the contributors for their generosity and courtesy of OCT scans in certain cases.

Atul Dhawan, Hina Khan, Zrenie ophthalmological center, Sengul Ozdek, www.eyecarePD.com, and Mohamed Ahmed Tawfik


Atlas is available at :

https://www.amazon.com/dp/B08P27114J?ref_=pe_3052080_397514860 

Clinical guidelines for approaching and managing common retinal diseases: Making retina straightforward 

By Ameen Marashi, MD (Mid 2020)

The clinical guidelines for approaching and managing common retinal diseases are to help and to inlight the retinal path of each ophthalmologist. Because experience is not taught in books, I deliberately made something different and combined the sum of evidence-based medicine and several references to deliver that guidelines for a safer clinical practice. I know this is not an easy task, and some cases require individualization for each patient and that the world of the retina is broad with a bumpy path. However, I have striven to find a straightforward way that leads you to the righteousness of the correct clinical evaluation, which I didn't find at the beginning of my entry into the world of the retina. I hope you find these guidelines useful in your daily retinal clinical practice. 

https://www.amazon.com/dp/B08BWGQ4V6/ref=sr_1_1?dchild=1&keywords=Ameen+Marashi+MD&qid=1593337939&sr=8-1

‫دليل الممارسة السريرية لمقاربة وتدبير الأمراض الشبكية الشائعة: جعل طريق الشبكية أسهل‬ 

(Arabic Edition) Kindle Edition

By Ameen Marashi (Mid 2020)

تعتبر الأمراض الشبكية من إحدى الأسباب المؤدية لتدني الرؤية في ممارستنا السريرية

يوجد اختلاف في وجهات النظر حول مقاربة وتدبير الأمراض الشبكية ، لذا طلبت مني الجمعية السورية لأطباء العين كتابة دليل ممارسة لمقاربة وتدبير الأمراض الشبكية التي نواجهها في حياتنا اليومية لمساعدة الزملاء وأطباء عيون المستقبل لاكتساب الخبرة في مقاربة وتدبير الأمراض الشبكية فقط

اعتمدت على أحدث التوصيات السريرية المعتمدة على الطب المسند بالدليل

لايحتوي الكتاب على سرد للآلية الإمراضية للأمراض أو التصنيفات أو التشاخيص التفريقية

يحتوي هذا الكتاب على 21 دليل ليُغطي 30 مرض شائع في الشبكية

يُساعد الدليل أطباء العيون على معرفة أهم الأشياء المطلوب سؤالها للمريض عند أخذ القصة السريرية وتقييم الحالة بالفحص السريري ولمعرفة الفحوص العينية المطلوب إجراؤها وما نتوقع مشاهدته بها 

يناقش الدليل الخيارات والخطط العلاجية للحالات السريرية الشائعة في الممارسة العملية ومتابعة المرضى ومعرفة إنذار المرض مابعد العلاج مع مخططات بيانية تُلخص مقاربة وتدبير هذه الأمراض

إن مقاربة وتدبير الأمراض الشبكية ليست بالأمر السهل وتحتاج لعدة سنوات من الخبرة و لزمالة جيدة

اجتهدت في هذا الكتاب لتقديم دليل ممارسة بلغة مفهومة بسيطة مع مخططات بيانية لمساعدة أطباء العيون بالقيام بممارسة سريرية آمنة عند مقاربة وتدبير الأمراض الشبكية

عليك أن تعرف أن هذا الكتاب ليس بديلاً عن الخبرة الشخصية الفردية بإجراء المناسب لكل مريض اعتماداً على حالة المريض وخبرة الطبيب والموارد المتاحة

لدي حلم بأن يصبح الدليل كمشروع مفتوح (open source) بحيث يتمكن جميع أخصائيي الشبكية حول العالم بالمساهمة بإضافة معلومات جديدة وأتمنى أن أتمكن من تطوير هذا الكتاب في السنوات القادمة ليبقى مواكباً لأحدث التوصيات العالم 


https://www.amazon.com/%D8%A7%D9%84%D9%85%D9%85%D8%A7%D8%B1%D8%B3%D8%A9-%D8%A7%D9%84%D8%B3%D8%B1%D9%8A%D8%B1%D9%8A%D8%A9-%D9%84%D9%85%D9%82%D8%A7%D8%B1%D8%A8%D8%A9-%D8%A7%D9%84%D8%A3%D9%85%D8%B1%D8%A7%D8%B6-%D8%A7%D9%84%D8%B4%D8%A8%D9%83%D9%8A%D8%A9-ebook/dp/B08HDNP5LT/ref=sr_1_1?dchild=1&keywords=Ameen+Marashi&qid=1601199808&sr=8-1

Clinical Diabetic Retinopathy: Step by step for management and decision making 

By Ameen Marashi, MD (Late 2017)

Diabetic retinopathy is the fifth leading cause of blindness and is very common in ophthalmic practice, dealing with it is a daily challenge, and treating patients with diabetic retinopathy properly can save sight and improve their quality of life.This book aims to help comprehending the pathology, imaging techniques, therapeutic modalities, patient approach, clinical features and straight forward treatment plans of diabetic retinopathy, maculopathy and their complications in a modern and practical manner with the help of algorithms and illustrations which provides cutting edge information and covering various clinical scenarios such as proliferative and nonproliferative diabetic retinopathy, vitreous hemorrhage, tractional retinal detachment, rubeosis iridis, central and non-central diabetic macular edema, vitreomacular abnormalities, macular ischemia, and treatment complications. 

https://www.amazon.com/Clinical-Diabetic-Retinopathy-management-decision/dp/6202094788

 : السريريات في اعتلال الشبكية السكري 

خطوة بخطوة نحو اتخاذ القرار العلاج

By Ameen Marashi, MD (Early 2018)

اعتلال الشبكية السكري خامس سبب للعمى وهو شائع جدا خلال الممارسة السريرية ويعتبر التعامل معه أحد التحديات اليومية ، علماً أن علاج مرضى اعتلال الشبكية السكري بشكل صحيح قد  يحافظ على رؤية المرضى ويحسن نوعية حياة المرضى.

يهدف الكتاب إلى المساعدة في فهم الألية الإمراضية وطرائق تصوير وأساليب علاج ومقاربة المرضى والمظاهر السريرية ووضع خطة علاج مرضى اعتلال الشبكية السكري واعتلال اللطخة واختلاطات العلاج بطريقة عملية وحديثة بمساعدة خوارزميات ورسومات كما يغطي الكتاب العديد من السيناريوهات التي قد تواجه الطبيب كاعتلال الشبكية السكري التكاثري واللاتكاثري ونزف الزجاجي وانفصال الشبكية الشدي وتوعي القزحية ووذمة اللطخة السكرية اللامركزية والمركزية و الاضطرابات اللطخية الزجاجية وإقفار اللطخة واختلاطات العلاج

https://1drv.ms/b/s!ArXDCgnmWD9_lxVYBltoyVQoRCr1

Quick uveitis

By Ameen Marashi, MD (2013)

This book is written as algorithms and text configuration, where algorithms are made to help us, doctors, easily diagnose and treat patients with the most common uveitis cases, where the text is made to summarize diseases in the algorithms.

 

This book is divided into chapters such as principles of treatment infectious, noninfectious inflammatory, masqueraded diseases, and algorithms. As you noticed, there are no pictures in the text chapters because I don't have pictures of uveitis cases that are mine, and I don't have any attention to violate any copyrights.

CASE REPORT

A 5-years-old Syrian female was born with Oguchi disease: a rare case report

Habeeb, Rashaa; Baba, Marwab; Bazkke, Basharc; Zazo, Ayac; Marashi, Ameend

Abstract

Introduction: 

Oguchi disaese is a rare autosomal recessive disease causes congenital stationary blindness which distinguished by (The Mizuo-Nakamura phenomenon) and caused by mutations of Rhodopsin kinase gene or the Artestin gene.

Case Presentation: 

A 5-years old syrian female complains from stationary night blindness, investigated by Fundus photo and Optical coherrence photograph and diagnosed as Ogushi disease.

Discussion: 

Ogushi disease is an autosomal recessive retinal disorder causing stationary nyctalopia. It is characterized by Mizuo-Nakamura phenomenon which is the alteration of fundus reflex color from golden-yellow to normal with dark adaptation. Literature reports suggest that mutations in rhodopsin kinase or arrestin genes may cause Oguchi’s disease.

Conclusion: 

Optical coherence tomography is of great importance in Oguchi’s Disease. OCT shows usually an absence of IS/OS line in the extrafoveal area during partly dark-adaptation phase.


Habeeb, Rashaa; Baba, Marwab; Bazkke, Basharc; Zazo, Ayac; Marashi, Ameend. A 5-years-old Syrian female was born with Oguchi disease: a rare case report. Annals of Medicine & Surgery ():10.1097/MS9.0000000000000100, March 27, 2023. | DOI: 10.1097/MS9.0000000000000100 


https://journals.lww.com/annals-of-medicine-and-surgery/Abstract/9900/A_5_years_old_Syrian_female_was_born_with_Oguchi.204.aspx


Hybrid threshold laser to treat diabetic macular edema: A retrospective analysis single center cohort study

Ameen Marashi 1, Aya Zazo 2

PMID: 36045820 PMCID: PMC9422176 DOI: 10.1016/j.amsu.2022.104222

Abstract

Background: Diabetic patients suffers from reduction of vision that one of its main causes is clinically significant macular edema (CSME).The purpose of this study to determine if hybrid threshold can reduce macular thickness in Diabetic Macular Edema.

Materials and methods: This study is a retrospective analysis single center cohort study. 12 eyes in 10 patients diagnosed with diabetic macular edema using SD-OCT treated with Hybridthreshold laser as the leaking microaneurysms were treated with threshold laser on the 5% duty cycle settings.A complete fundus exam, including best-corrected visual acuity changes, and monthly measuring retinal thickness using SD-OCT for 24 weeks follow up.

Results: Reduction of retinal thickness from 336.58 ± 86.26 μm to 264.33 ± 61.41 μm (p = 0.02) at 24 weeks follow up without significant changes of best-corrected visual acuity from 0.16 LogMAR to 0.08 LogMAR (p = 0.2) with minimal scar formation in 24 weeks follow up.

Conclusion: 532 nm Hybridthreshold laser reduces macular thickness up to 20% and stabilizes diabetic macular edema for 24 weeks follow up.

https://pubmed.ncbi.nlm.nih.gov/36045820/

Marashi A, Zazo A. Hybrid threshold laser to treat diabetic macular edema: A retrospective analysis single center cohort study. Ann Med Surg (Lond). 2022 Jul 31;80:104222. doi: 10.1016/j.amsu.2022.104222. PMID: 36045820; PMCID: PMC9422176.


A manually made needle for treating Pseudophakic cystoid macular edema by injecting triamcinolone acetonide in the suprachoroidal space: A case report

Abstract

Purpose

This case was conducted to report the effectiveness and security of a manually made needle to inject triamcinolone acetonide in the suprachoroidal space (SCS) in a 52-year-old female with pseudophakic cystoid macular edema (PCME) in the challenging socio-economical situations in Syria.

Methods

This case report is an interventional case of a 52-year-old female presented with a four-week history of reduced vision secondary to Pseudophakic cystoid macular edema (PCME). The patient attended Marashi Eye Clinic Center for a clinical examination and followed up with Optical Coherence Tomography (OCT) at baseline. The patient was treated by one injection of triamcinolone acetonide and followed up within one week, 4 weeks, 8 weeks, 16 weeks, and 24 weeks in the suprachoroidal space (SCS) using a manually made needle with assessing the efficacy and potential ocular complications.

Results

The best-corrected visual acuity (BCVA) had improved significantly from baseline 20/60 to 20/30 at 24 weeks with a complete anatomical resolution of macular edema at 24 weeks from baseline. No ocular complications were noticed during the study period.

Conclusions and Importance

Injecting triamcinolone acetonide in suprachoroidal space (SCS) using a manually made needle plays an essential role in treating Pseudophakic cystoid macular edema (PCME) without compromising security and efficiency.

Ameen Marashi, Aya Zazo, A manually made needle for treating Pseudophakic cystoid macular edema by injecting triamcinolone acetonide in the suprachoroidal space: A case report, American Journal of Ophthalmology Case Reports, Volume 25, 2022, 101254, ISSN 2451-9936, https://doi.org/10.1016/j.ajoc.2021.101254.

(https://www.sciencedirect.com/science/article/pii/S2451993621002632)



Suprachoroidal injection of triamcinolone acetonide using a custom-made needle to treat diabetic macular edema post pars plana vitrectomy: a case series

Abstract

Objective

Diabetic macular edema (DME), the most common cause of diabetes-related visual impairment, may occur following pars plana vitrectomy (PPV) to manage proliferative diabetic retinopathy complications. This retrospective single-centre case series evaluated the efficacy and safety of injecting 4 mg/0.1 ml triamcinolone into the suprachoroidal space using a custom-made needle to treat DME post PPV.

Methods

Data regarding central macular thickness (CMT) using spectral domain-optical coherence tomography and best-corrected visual acuity (by Snellen chart) at baseline (pre-injection), and at 1, 4, and 8 weeks following injection were analysed, along with intraocular pressure (IOP), cataract progression, and ocular safety.

Results

Eleven eyes in 10 patients received 11 suprachoroidal injections. Vision improvement was noted (0.75 log minimum angle of resolution (MAR) at baseline to 0.40 log MAR after treatment). CMT reduced significantly from 456.45 ± 113.42 μm at baseline to 247.63 ± 53.40 μm at 8 weeks following injection. No rise in IOP, or cataract development in the single treated phakic eye, was observed during 8 weeks of follow-up.

Conclusion

Suprachoroidal injection of triamcinolone using a custom-made needle to treat DME post PPV shows promising results with acceptable safety outcomes. Large clinical trials with longer follow-up are needed to evaluate this treatment option for countries with limited health-care resources.


Marashi A, Zazo A. Suprachoroidal injection of triamcinolone acetonide using a custom-made needle to treat diabetic macular edema post pars plana vitrectomy: a case series. Journal of International Medical Research. 2022;50(4). doi:10.1177/03000605221089807

COPY CITATION


https://pubmed.ncbi.nlm.nih.gov/35414288/


Myths and Truths of the association of retinal vascular occlusion with COVID-19

2021 Dec 3. 

Abstract

Purpose: To critically review data published in the recent past to scrutinize a causal relationship between retinal vascular occlusion and COVID-19.

Method: A comprehensive literature search was performed on Pubmed with the key words retinal vascular occlusion, retinal vein occlusion, retinal artery occlusion and COVID-19.

Results: A total of 17 case reports were published during this period and 10 were on retinal vein occlusion and 7 on retinal artery occlusion. Most of the published reports lacked convincing evidences in one or the other aspects such as insufficient laboratory workup or presence of multiple confounding risk factors.

Conclusion: In this index manuscript, strength of the data is insufficient to establish a definitive cause-and-effect relationship of retinal vascular occlusive disorders with COVID-19. Hence, clinicians can continue to manage these cases according to the standard guidelines until there are more robust evidences to support this association to alter the diagnostic and treatment modalities.


Cite as : Sharma A, Parachuri N, Kumar N, Romano MR, Parolini B, Ozdek S, Tawfik MA, Marashi A, Kuppermann BD, Nguyen QD. Myths and Truths of the association of retinal vascular occlusion with COVID-19. Retina. 2021 Dec 3. doi: 10.1097/IAE.0000000000003371. Epub ahead of print. PMID: 34907124.

https://pubmed.ncbi.nlm.nih.gov/34907124/

Managing solar retinopathy with suprachoroidal triamcinolone acetonide injection in a young girl: a case report

Background

Solar retinopathy is a disease that causes photochemical toxicity in the retinal fovea tissues, leading to an acute decrease of vision.

Case presentation

This case report is an interventional case of an asymptomatic 17-year-old Caucasian female with a history of suddenly decreased vision due to solar retinopathy. The patient was managed with a custom-made needle injection of triamcinolone acetonide in the suprachoroidal space. Four months post suprachoroidal injection showed an anatomical and functional improvement in the ellipsoid zone layer through optical coherence tomography signal reappearance. In addition, the best-corrected visual acuity had improved from 0.1 to 1.0 on the Snellen chart with the disappearance of the scotoma. However, there was a mild increase in intraocular pressure after this procedure, controlled with topical hypertensive eye drops.

Conclusion

Suprachoroidal triamcinolone acetonide injection using a custom-made needle showed both functional and anatomical improvement of macular changes post-solar retinopathy, with acceptable safety outcomes in a young female.


Cite:Marashi, A., Baba, M. & Zazo, A. Managing solar retinopathy with suprachoroidal triamcinolone acetonide injection in a young girl: a case report. J Med Case Reports 15, 577 (2021). https://doi.org/10.1186/s13256-021-03162-0

https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-021-03162-0

Perspective on retinal findings in COVID-19

October 13, 2020 

Editorial about concerns for  OCT findings for patients with COVID-19  previously reported Marinho. et al.

https://medcraveonline.com/AOVS/perspective-on-retinal-findings-in-covid-19.html 

Suprachoroidal injection of triamcinolone for DME treatment 

1/May/2020

Diabetic macular edema (DME) is a leading cause of early-onset vision loss and blindness among working-age adults. The disease is commonly treated with steroids. Targeting the suprachoroidal space may represent a safe and effective option for steroid delivery in patients with DME.

https://retinatoday.com/articles/2020-may-june/the-mother-of-invention-making-custom-equipment-in-syria

Safety of 6000 intravitreal dexamethasone implants.

Apr 30, 2019  

Abstract

PURPOSE:

To evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions.

METHODS:

Retrospective multicenter analysis of intravitreal dexamethasone implant injections (700 µg) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period.

RESULTS:

A total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7±12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up.

CONCLUSION:

This is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable. 

https://pubmed.ncbi.nlm.nih.gov/31040132/


Treating macular edema secondary to retinal vein occlusion with suprachoroidal injection of triamcinolone acetonide using custom made needle

Oct 22, 2018 


Purpose: To report the efficacy and safety of suprachoroidal injection of triamcinolone acetonide using custom made needle in a 76 years old male with macular edema due to retinal vein occlusion.


Methods: This was interventional case report, of a symptomatic 76years’ old male with history of macular edema due to branch retinal vein occlusion, underwent for clinical examination and follow up with optical coherence tomography at baseline, one week, 4weeks and 8 weeks of treatment with single injection of triamcinolone acetonide in suprachoroidal space using custom made needle with evaluation efficacy and possible of ocular complications.


Results: Improvement of best corrected visual acuity from baseline 20/100 to 20/30 at 8 weeks with resolution of macular edema and intraretinal hemorrhages at 8weeks from baseline with no signs of ocular complications.


Conclusions: Injection of triamcinolone acetonide in suprachoroidal space using custom made needle seems to be safe and effective in treatment macular edema due to retinal vein occlusion. 

https://medcraveonline.com/AOVS/AOVS-08-00321

Safety of 5914 intravitreal aflibercept injections

Aug 11, 2018  

publication description

BJO

publication description

Purpose To analyse the pooled safety data of intravitreal ziv-aflibercept (IVZ) therapy for various retinal conditions.


Methods This was a retrospective, observational study which included patients from 14 participating centres who received IVZ. The medical records of patients who received IVZ from March 2015 through October 2017 were evaluated. Patient demographics and ocular details were compiled. Ocular and systemic adverse events that occurred within 1 month of IVZ injections were recorded and defined as either procedure-related or drug-related.


Results A total of 1704 eyes of 1562 patients received 5914 IVZ injections (mean±SD: 3.73±3.94) during a period of 2.5 years. The age of patients was 60.6±12.8 years (mean±SD) and included diverse chorioretinal pathologies. Both ocular (one case of endophthalmitis, three cases of intraocular inflammation, and one case each of conjunctival thinning/necrosis and scleral nodule) and systemic adverse events (two cases of myocardial infarction, one case of stroke and two deaths) were infrequent.


Conclusion This constitutes the largest pooled safety report on IVZ use and includes patients from 14 centres distributed across the globe. It shows that IVZ has an acceptable ocular and systemic safety profile with incidences of adverse events similar to those of other vascular endothelial growth factor inhibitory drugs. The analysis supports the continued use of IVZ in various retinal disorders.

https://bjo.bmj.com/content/103/6/805

Non-central diabetic clinical significant macular edema treatment with 532nm sub threshold laser

May 17, 2018  

publication description

Medcrave

publication description

Purpose: is to determine if Sub Threshold Laser at 532 nm can reduce macular thickness in non-central Clinical Significant Macular Edema (CSME) and stop the progression of non-central CSME to central CSME.


Methods: 8 eyes in 6 patients were diagnosed with non-central CSME using OCT and were treated with Sub Threshold Laser at 532 nm using 5 % duty cycle using high density low intensity application on the area of the edema, retreatment was allowed with Sub Threshold Laser whenever macular edema worsening.


Main outcome and measures: A complete fundus exam including best-corrected visual acuity changes within 24 weeks, improvement of non-central retinal thickness and monitoring glycemic control.


Results: Reduction of retinal thickness from 384.5±64.5µm to 311.33±51.7µm at 24 weeks follow up (P<0.05) without changes of best corrected visual acuity along with reduced risk of progression to central CSME and visual loss with no sign of laser burns at the macular area.


Conclusion: 532nm subthreshold laser is effective in NON-central CSME treatment for 24 weeks follow up and reduce the risk of visual loss due development of central CSME without causing retinal scars.

https://medcraveonline.com/AOVS/AOVS-08-00291.pdf

Trends in treating chronic persistent diabetic macular edema

Apr 18, 2018  

publication description

Medcrave

publication description

Chronic persistent diabetic macular edema responds poorly to intravitreal Anti-VEGF treatment, due to dominance of inflammatory cytokines in the pathogenesis, optical coherence tomography is important tool to evaluate structural changes and visual prognosis in diabetic macular edema. Multiple studies showed the efficacy of intravitreal steroids treatment and intravitreal Anti-VEGF agents may reduce the risk of visual loss in cases of chronic persistent diabetic macular edema. When optical coherence tomography shows signs of disorganization of inner retinal layer and interruption of ellipsoid zone in light of diabetic macular edema that responds poorly to Anti-VEGF treatment then switching to intravitreal steroids recommended.

https://medcraveonline.com/AOVS/AOVS-08-00281


Panretinal Photocoagulation versus Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy Treatment

Jun 30, 2017  

publication description

Advances in Ophthalmology & Visual System 

Abstract
Purpose: It is to determine the visual acuity outcomes at 1 year in eyes with proliferative diabetic retinopathy using pan retinal photocoagulation compared to intravitreal Bevacizumab 1.25 mg instead of Ranbizumab to lower the cost burden.

Methods: 30 eyes of 30 patients diagnosed with proliferative diabetic retinopathy and have randomized for either pan retinal laser photocoagulation or intravitreal Bevacizumab every 4 weeks based on retreatment protocol both groups can receive intravitreal bevacizumab or focal/grid laser for diabetic macular edema.

Main outcome and measures: A complete exam including best corrected visual acuity changes within 52 weeks, improvement in diabetic retinopathy, central retinal thickness and cost analysis.

Results: Best corrected visual acuity changed from the baseline 0.60 LogMAR in the of Bevacizumab group and 0.50 LogMAR in the PRP group, to 0.40 LogMAR in the Bevacizumab group and 0.50 LogMAR in the PRP group at week 52 (P=0.14), where central retinal thickness changes at 52 weeks from baseline -48 (-62 to -32) in the Bevacizumab group and -16 (-21 to -8) in the PRP group (p<0.001) however proportion of eyes without active or regressed neovascularization at 52 weeks are statistically not significant between two groups (p=0.43).

Conclusion: Intravitreal Bevacizumab is non-inferior to pan retinal photocoagulation interim of visual acuity outcome within 52 weeks in case of proliferative diabetic retinopathy and may be more cost effective in selected cases of proliferative diabetic retinopathy with diabetic macular edema than both panretinal photocoagulation and Ranibizumab but a long term and larger studies are needed.

https://medcraveonline.com/AOVS/panretinal-photocoagulation-versus-intravitreal-bevacizumab-for-proliferative-diabetic-retinopathy-treatment.html


Laser Therapy for Diabetic Retinopathy and Diabetic Macular Edema

publication date Jun 1, 2017  publication descriptionRetina Today

publication description

Laser is still the treatment of choice in patients with PDR and non–center-involving CSME. In central DME, laser can be used as an adjuvant treatment to reduce the need for intravitreal injections and to delay the need for retreatment. Use of SDM laser may be safer and more effective than conventional CW laser, with better visual outcomes.

• In eyes with vitreous hemorrhage as a complication of PDR, laser can help to prevent further vitreous hemorrhage and encourage its clearance.

• It is important to be very familiar with the laser machine and lenses you plan to use before applying laser treatment in PDR and DME.

• Laser has a place as both first- and second-line therapy for DME, but it should always be combined with good glycemic control (HbA1C of 7% or less).

• When laser treatment for DME is planned, it is recommended to use OCT maps or fluorescein angiography as a guide to ensure accurate laser placement.

https://retinatoday.com/articles/2017-may-june/laser-therapy-for-diabetic-retinopathy-and-diabetic-macular-edema

Effect of Intravitreal Aflibercept on Choroidal Neovascularization Membrane Secondary to Post Traumatic Choroidal Rupture

Apr 19, 2017  

Purpose: To report the efficacy and safety of intravitreal ziv-aflibercept in a young female with choroidal neovascularization membrane secondary to post traumatic choroidal rupture.


Methods:T his was interventional case report, of a symptomatic 15 years’ old female with history of blunt trauma presented for reduced vision, underwent for clinical examination and fluorescein angiography at baseline and 12 weeks of treatment with three consecutive intravitreal injection of ziv-aflibercept1.25 mg every 4 weeks with evaluation of ocular and systemic complications.


Results: Improvement of best corrected visual acuity from baseline LogMAR 0.30 and 0.10 at 12 weeks with marked regression of choroidal neovascularization membrane on fluorescein angiogram a 12 weeks from baseline with no signs of ocular nor systemic complications.


Conclusions: Ziv-Aflibercept seems to be safe and effective in treatment of choroidal neovascularization membrane post traumatic choroidal rupture for 12 weeks follow up. 

https://medcraveonline.com/AOVS/AOVS-06-00197

Free Medical Retina for the Poor

Mar 15, 2017 

Treatment of retinal disease can be a huge burden for the patients causing

financial issues and thus can be added to war circumstances that made poverty

pandemic especially in elderly individuals, so the free medical retina service can

offer relief and improve quality of life for the poor by funding it from rich people

using the zakkah system. 

http://medcraveonline.com/AOVS/AOVS-06-00183.pdf

Clinical Pathology of Diabetic Retinopathy and Macular Edema

Jul 2016  

publication description

Open Access Journal of Ophthalmology

publication description

Diabetic retinopathy and macular edema is multifactorial complex disease, VEGF can play central role in non- chronic diabetic macular edema pathogenesis and VEGF blockade agents may improve vision, where in chronic diabetic macular edema inflammatory cytokines are the main driver of edema and intravitreal steroids may result in edema resolution, however vascular element is not always the cause of macular thickening and visual loss from non- vascular elements such as vitreomacular abnormalities which needs to be managed surgically, while diabetic retinopathy can be non-proliferative or proliferative in the presence of neovascularization which they managed by pan retinal laser photocoagulation and proliferation can complicate in to tractoinal retinal detachment and vitreous hemorrhage, which may require surgical management in certain cases.

https://medwinpublishers.com/OAJO/OAJO16000105.pdf

Using Steroids in Diabetic Macular Edema: A Guide for Steroid Application in Clinical Practice

publication date

Jul 2016  

publication description

actamedicainternational

publication description

Diabetic macular edema is a multi-pathogenic diseases which vascular endothelial growth factor (VEGF) may play the main role in most of the cases and treatment with Anti VEGF is warranted, where in long standing edema in ammation maybe the main pathogenic factor and treatment with Anti VEGF may not achieve optimum results and steroids can be used to address the in ammatory mechanism, there are three classes of intravitreal steroids which help us to individualize treatment for each patient never the less we have to take into account that all intravitreal steroids may cause cataract formation and glaucoma.

http://www.actamedicainternational.com/article.asp?issn=2349-0578;year=2016;volume=3;issue=2;spage=171;epage=174;aulast=Marashi

Using Anti-VEGF in Diabetic Retinopathy

publication date

Jun 27, 2016  

publication description

Adv Ophthalmol Vis Syst

publication description

Vascular endothelium growth factor is the main pathological factor in diabetic retinopathy and diabetic macular edema (DME), Anti-VEGF agents are safe and effective in DME treatment, there are multiple Anti-VEGF agents, choosing between them is essential to individualize treatment for each patient to achieve the optimum results.

http://medcraveonline.com/AOVS/AOVS-04-00116.php

Management of Diabetic Macular Edema

publication date

Apr 1, 2016  

publication description

Retinal Physician

publication description

An algorithm for treatment decision-making

https://www.retinalphysician.com/issues/2016/april-2016/management-of-diabetic-macular-edema

Pearls for Treating Patients With Diabetic Retinopathy

publication date

Jan 1, 2016  

publication description

Retinal Physician

publication description

An illustrated, step-by-step guide to management

https://www.retinalphysician.com/issues/2016/jan-feb/pearls-for-treating-patients-with-diabetic-retinop

Three-month outcome of ZIV-AFLIBERCEPT for diabetic macular edema

May 16, 2016  

Purpose: Is to show the 3-month efficacy and safety of treatment diabetic macular edema treated with intravitreal ziv-aflibercept as studies have shown that Ziv-aflibercept does not cause retinal pigment epithelial toxicity and to study it cost effectiveness.

Methods: Ten eyes in eight patients diagnosed with central diabetic macular edema were enrolled for three consecutive intravitreal injection of ziv-aflibercept 1.25 mg every 4 weeks, a complete exam including BCVA and CRT at baseline and 12 weeks with evaluation of ocular and systemic complications.

Results: Improvement of best corrected visual acuity was clinically significant from baseline LogMAR 0.77 and 0.35 at 12 weeks and statistically significant (P<0.05) along with reduction of central retinal thickness from 562,4 µm and 317.7 µm at 12 weeks follow up (P<0.05) with no signs of ocular nor systemic complications.

Conclusion: Ziv aflibercept is a safe and effective in diabetic macular edema treatment for 12 weeks follow up with cost effectiveness especially in countries where aflibercept is not available.

Keywords: dme, anti vegf, vegf trap, diabetes, diabetic retinopathy, zaltrap, ziv aflibercept

http://medcraveonline.com/AOVS/AOVS-04-00114.php

Decisions for Imaging in DME

publication date

Jul 1, 2015  

publication description

Retinal Physician

publication description

A brief guide to diagnosis and management with images

https://www.retinalphysician.com/issues/2015/july-aug/decisions-for-imaging-in-dme